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ROLE OF PHOSPHORYLATED INSULIN-LIKE GROWTH FACTOR BINDING PROTEIN-1 AS PREDICTOR OF SUCCESSFUL LABOR INDUCTION IN FULL TERM PREGNANCY - A CROSS SECTIONAL STUDY

Mon, 01 Jul 2024 00:00:00 GMT

Title: ROLE OF PHOSPHORYLATED INSULIN-LIKE GROWTH FACTOR BINDING PROTEIN-1 AS PREDICTOR OF SUCCESSFUL LABOR INDUCTION IN FULL TERM PREGNANCY - A CROSS SECTIONAL STUDY Authors: AJITHA, KOLAKOTLA Abstract: BACKGROUND: Induction of labor is the artificial initiation of uterine contractions before its spontaneous onset to deliver the feto-placental unit. Induction of labor is one of the most important part of obstetrics, as we can interfere and induce labor as a lifesaving procedure for mother or fetus or both. The frequency of inducing labor to reduce the gestational period due to various indications has increased. Hence pre induction biomarkers are necessary to predict the successful induction of labor and mode of delivery. In this study Phosphorylated Insulin like growth factor binding protein 1 (phIGFBP-1), an emerging pre-induction biomarker is used to predict the successful labor induction. AIM: To detect the presence of Phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) in patients undergoing induction of labor using Actim partus test and to evaluate the presence of Phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) among the patients with and without successful induction of labor. MATERIALS & METHODS: All the consenting eligible pregnant women who were hospitalized to the labor room were recruited for the study. Cervicovaginal swab from the women who are undergoing labor induction is taken and tested for presence Insulin-like growth factor binding protein 1 (IGFBP1), using Actim partus test. Then assessment will be made about mode of delivery in patients with and without phosphorylated insulin like growth factor binding protein 1 positive. RESULTS: This study included 58 pregnant women who were over 37 weeks pregnant and were scheduled for induction. The findings showed that approximately half were primigravida mothers, followed by gravida 2 (29.3%) and 3 (22.4%). Most of the patients had a gestational age of more than 40 weeks (50%). Foleys's + Misoprostol + Oxytocin was the most common induction method used (32.8%), followed by Foleys's +Misoprostol (22.4%) and misoprostol xx only (22.4%). Most of the patients had a vaginal delivery (77.6%), while 22.4% had LSCS. Overall, the labor induction was successful among 93.1% of pregnant women. In this study, the Actim partus test was positive in 79% of the cases. Most pregnant women scored a BISHOP score of 5 and above (70.7%), whereas 29.3% scored lower than 5. The presence of phIGFBP-1 in the cervicovaginal fluid is identified as a significant factor in predicting labor. The sensitivity, specificity, PPV, NPV, and accuracy of the phIGFBP-1 in predicting successful labor induction were 85.2%, 100%, 100%, 33.3%, and 86.2%, respectively.

TO DETERMINE THE EFFECT OF VAGINAL PH ON EFFICACY OF DINOPROSTONE GEL FOR LABOUR INDUCTION-PROSPECTIVE OBSERVATIONAL STUDY

Mon, 01 Jul 2024 00:00:00 GMT

Title: TO DETERMINE THE EFFECT OF VAGINAL PH ON EFFICACY OF DINOPROSTONE GEL FOR LABOUR INDUCTION-PROSPECTIVE OBSERVATIONAL STUDY Authors: SAI LAKSHMI SHREYA, CHINTHALA Abstract: Introduction: Induction of labour (IOL) has been increased significantly in the recent days. It is widely acknowledged that IOL is appropriate when the potential benefits for the fetus, mother, or both outweigh those of expectant management, which involves waiting for spontaneous labour to begin. Among the many pharmacological methods of labour induction, prostaglandins like dinoprostone gel are a widely used method. The success of IOL depends on several factors including the clinical condition of the patient at the time of induction, induction methods, pH of the vagina and other predictive factors. Given the complexity of factors influencing the success of labour induction, including biochemical, physiological, and clinical parameters, this study explores the specific role of vaginal pH in modifying the efficacy of PGE2 gel-based labour induction methods. Understanding these interactions will provide critical insights into optimizing induction protocols, potentially improving maternal and fetal outcomes. Objectives: To determine the vaginal pH and classify as high (pH >4.5) and low vaginal pH (pH ≤4.5); and to determine if the vaginal pH has any effect on the action of PGE2 gel for cervical ripening and labour induction. Methods: A prospective observational study was conducted in the department Obstetrics and Gynaecology of RL Jalappa Hospital, Kolar. All pregnant women underwent IOL during the study period were eligible for the study. Ninety participants with singleton pregnancy with cephalic presentation, having unfavourable modified Bishop score (≤ 5) and reactive NST were included in the study after obtaining informed consent. However, patients with known conditions including hypersensitivity to prostaglandins, placenta previa, suspected chorioamnionitis, malpresentation, cephalopelvic disproportion, previous caesarean delivery, and premature rupture of membranes were excluded from the study. xxii | P a g e The participating patients were clinically evaluated after taking a detailed obstetric, menstrual and medical history, supported by relevant investigations. Each participant underwent speculum examination and vaginal pH was assessed by using pH indicator paper. Based on the pH, patients were divided into two groups- Group A (pH ≤4.5) and Group B (pH >4.5). Following this, Modified Bishop score is assessed at the baseline and during subsequent follow-up vaginal examinations. All clinical assessments were done by the investigators according to the standard protocol of the hospital. Standard ethical practices were followed during the study. Results: The study included 90 term pregnant participants with equal distribution of low and high vaginal pH. The baseline characteristics of both groups like mean age, gestational age, parity, comorbidities, and pre-induction modified Bishop score was similar. Significant differences were noted between the two groups in favour of group B. Mean Bishop score improvement in group B (4.78 ±1.72) was high compared to group A (2.5 ±1.1). The dose repetitions were less among patients having a high vaginal pH. The mean time taken enter active phase of labour was substantially higher in group A (16.2 hours) compared to the group B (9.2 hours) participants. The proportion of normal delivery was significantly higher in group B (64.5%) compared to group A (40.0%). Conversely, group A had a high rate of LSCS (60.0%) compared to group B (35.5%). Conclusion: This study reveals that patients with higher vaginal pH (>4.5) experience better outcomes with dinoprostone-induced labour. Appreciable favourable outcomes were noted in cervical ripening, reduced induction requirements, and higher rates of normal delivery. These findings highlight the importance of examining the vaginal pH in predicting successful labour induction.

THE ROLE OF HbA1C AS AN EARLY PREDICTOR OF GESTATIONAL DIABETES MELLITUS IN EARLY PREGNANCY- A PROSPECTIVE STUDY

Mon, 01 Jul 2024 00:00:00 GMT

Title: THE ROLE OF HbA1C AS AN EARLY PREDICTOR OF GESTATIONAL DIABETES MELLITUS IN EARLY PREGNANCY- A PROSPECTIVE STUDY Authors: SOMAVARAPU DIVYA Abstract: BACKGROUND: Gestational Diabetes Mellitus (GDM) that starts or is first identified during pregnancy is known as gestational diabetes mellitus (GDM). Universally, gestational diabetes influences 90% of pregnant ladies. One out of ten pregnancies is connected to diabetes. Fetal and maternal results might be extreme in the event that gestational diabetes is either misdiagnosed or not oversaw as expected. A few examinations, nonetheless, have shown that the two moms and offspring of GDM ladies are at increased risk for creating type 2 diabetes later on. Rates of GDM are a lot higher in India, quite possibly of the most populated country on the planet, with gauges going from 10.3 to 14.3 percent. AIM AND OBJECTIVES: To evaluate the HbA1c in all to begin with first trimester pregnant women. To assess the connection of HbA1c in early pregnancy (8-12 weeks) and expectation of development of diabetes mellitus in second trimester (24-28 weeks) of pregnancy with oral glucose tolerance test (OGTT). METHODS: Seventy-five pregnant ladies going to the OB/GYN facility at Sri Devaraj Clinical School in Kolar, D.t., Karnataka's RL Jalappa medical clinic were the subjects of our forthcoming observational exploration. To gauge HbA1C and fasting blood glucose levels in the primary trimester, analysts submitted blood tests from all pregnant ladies who partook in the review. Between weeks 24 and 28, they had a 75 g OGTT, which is a normalized, one-step test. xx RESULTS: Majority of study members are old enough gathering <25yrs comprising 40(53.33%). Among every one of the members 57 (76%) were viewed as with typical HbA1c. Out of 18 ladies with unusual HbA1c values larger part 10(14.28%) have a place with 25-35 age bunch with P esteem viewed as 0.005 which is measurably huge. Comparatively with the movement old enough the frequency of GDM is likewise increasing with X2 esteem being 18.66 and P esteem <0.001 with high importance. Larger part of the ones who were signed up for the review were Primigravida 46 (61.33%). With increase in equality poor glycaemic control is seen with X2 esteem being 9.68 and P esteem 0.002 which is huge. Frequency of GDM is increased with equality with P esteem <0.001 with high importance. It was observed that there is no relationship between's financial status and event of GDM. ROC Bend for HbA1c in first trimester in anticipating GDM viewed as exceptionally critical with P worth of <0.0001. Huge cut off HbA1C esteem in foreseeing diabetes mellitus by OGTT was viewed as 5.7 (with Awareness is 100 percent and Misleading energy rate is 0%) CONCLUSION: Estimation of HbA1c in first trimester is a good predictor for occurrence of GDM in second trimester. Life style modification and Medical nutrition therapy can be advised to those women who are with poor glycemic control in first trimester there by preventing the complications of GDM later in pregnancy, intrapartum and postpartum. This may also prevent occurrence of DM in progeny.

DETERMINATION OF MOLECULAR TUMOR MARKER LEVELS HE4 (HUMAN EPIDIDYMIS PROTEIN 4) AND CA125 IN OVARIAN CANCERS”: A CROSS SECTIONAL STUDY

Mon, 01 Jul 2024 00:00:00 GMT

Title: DETERMINATION OF MOLECULAR TUMOR MARKER LEVELS HE4 (HUMAN EPIDIDYMIS PROTEIN 4) AND CA125 IN OVARIAN CANCERS”: A CROSS SECTIONAL STUDY Authors: RADHIKA, S R Abstract: BACKGROUND: The determination of molecular tumor markers HE4 (Human Epididymis Protein 4) and CA125 has become increasingly important for managing ovarian cancer. Ovarian cancer is asymptomatic, because it is often discovered at an advanced stage, and the death rate is increased. CA125 has been a traditional biomarker for ovarian cancer, but its limitations include false positives and poor sensitivity in early-stage disease.HE4, a newer biomarker, offers enhanced sensitivity and specificity, particularly when distinguishing benign gynecological disorders from ovarian cancer. Combining HE4 and CA125 biomarkers along with calculating the ‘Risk of ovarian malignancy algorithm’,‘ Risk malignancy index’enhances accuracy for diagnosis, facilitating better differentiation, whether the condition is malignant and non-malignant. This dual-marker approach also improves the monitoring of treatment response and early detection of recurrence, contributing to more effective clinical management and improved patient outcomes. AIMS: The overall aim of conducting the study is the evaluation of the molecular tumor markers level for those patients that have been diagnosed with ovarian tumors, notably CA125 and HE4 MATERIALS & METHODS: Women diagnosed with ovarian cancer, who had given consent for study underwent routine physical examination. Preoperative evaluations such as CA 125, and HE4 were done, and ROMA and the Risk malignancy index were calculated. “Elecsys CA 125 II and Elecsys HE4 test reagents” were used together with Cobas E 602 immunoassay analyzer to conduct the HE4 and CA 125 tests.Surgical intervention was done for patients with suspected ovarian malignancy, and sample was sent for histopathological examination. RESULTS:54 females were part of the study population.HE 4 achieves a slightly higher diagnostic accuracy (69.45%) compared to CA 125 (65.56%). Overall, these metrics suggest HE 4 may be slightly more effective as a diagnostic biomarker than CA 125.But,combining HE4 and CA125 for diagnosis and assessing treatment response demonstrates notable efficacy. xx This study reported that the sensitivity of this combination is 90.12%,specificity is 82.64%, and positive predictive value is 96.12% independently. The overall precision of diagnosis of the HE4 and CA125 combination stands at 69.25%. CONCLUSION: The determination ofHE4 and CA125 levels is vitalin early diagnosis, treatment, and prevention of ovarian cancer. By overcoming current limitations through strategic recommendations. It is possible to maximize these biomarkers' clinical utility, leading to better patient care and outcomes.